Use of cell phones to send images via e-mail to consulting physicians at remote locations appears to be a feasible approach for visualization of chronic leg ulcerations, according to an article in the current issue of Archives of Dermatology.
Telemedicine, defined by the World Health Organization as the practice of health care using interactive audio, visual, and data communications, can include health care delivery, diagnosis, consultation, and treatment as well as education and transfer of medical data, according to background information in the article. Because leg ulcers and chronic wounds represent important cost factors for health care systems, with transportation costs representing a large percentage of these costs, telemedical wound care is an potentially important application of teledermatology, the authors suggest.
Ralph Peter Braun, M.D., of University Hospital of Geneva, Switzerland, and his colleagues performed a prospective study comparing face-to-face evaluation of leg wounds with remote evaluations to address the feasibility of taking images with cell phones, transmitting them to an expert at a distance and getting the expert's advice immediately. Over the course of three months, patients at their outpatient clinic, a total of 52 patients with 61 chronic wounds were evaluated by a physician who also took two images of the leg ulcer, an overview image covering the lower leg and the ulcer and a close-up picture covering the leg ulcer with surrounding skin. The images, taken under normal lighting conditions, were immediately transmitted (via the mobile telephone) to the e-mail accounts of two physicians who then made the remote diagnoses.
".We considered the face-to-face evaluation to be the gold standard because the physician saw the patient, saw and smelled the ulcer and the wound dressings, and was able to judge the context of the whole patient, his or her medical history and medical chart, and the presence of other diseases such as diabetes mellitus or arterial insufficiency," the researchers write.